Zusammenfassung
Die Trikuspidalklappenverletzung mit konsekutiver schwerer Trikuspidalklappen-Insuffizienz ist die häufigste kardiale Komplikation nach stumpfem Trauma. Wir präsentieren im Folgenden anhand vier klinischer Fallbeispiele die unterschiedlichen Erstsymptomen wie Pleuraergüsse, Arrhythmien, Zyanose, periphere Ödeme und Dyspnoe. Außerdem sind auch die zeitlichen Verläufe bis zum Symptomeintritt sowie die echokardiographischen und chirurgischen Befunde (Ruptur des Papillarmuskels bzw. der Chordae, Elongation der Chordae oder Perforation der Segel) individuell sehr variable, wie unsere Beispiele zeigen. Da die Diagnose oft erst sehr spät gestellt wird, die chirurgische Sanierung jedoch meist unerlässlich ist, erscheint eine frühe echokardiographische Untersuchung nach stumpfem Thoraxtrauma dringend indiziert, insbesondere bei Auftreten von Symptomen der Rechtsherzinsuffizienz.
Summary
Tricuspid valve injury causing severe tricuspid regurgitation is the most common cardiac complication following blunt chest trauma. We present four cases with different clinical presentations that included pleural effusion, arrhythmias, cyanosis, peripheral edema and dyspnea, with varying onset of symptoms. Echocardiographic evaluation and intraoperative findings in these patients revealed a broad spectrum of injury to the tricuspid valve including papillary muscle and chordal rupture, chordal elongation and leaflet perforation. Because surgical treatment is required in most patients and since the diagnosis is often delayed, we believe that early echocardiographic evaluation is required in all patients with blunt chest trauma, in particular if clinical symptoms of right heart failure are present.
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Schuster, I., Graf, S., Klaar, U. et al. Heterogeneity of traumatic injury of the tricuspid valve: A report of four cases. Wien Klin Wochenschr 120, 499–503 (2008). https://doi.org/10.1007/s00508-008-1012-7
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DOI: https://doi.org/10.1007/s00508-008-1012-7